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General NPI Number Information
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NPI Number | 1447809629
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Entity Type | Individual
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Provider Name | JEMMA COSTER
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Gender | Female
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 31872 COAST HWY
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-6773
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Country | US
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Telephone | 949-499-7501
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Fax |
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Provider Business Mailing Address
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Address Line | 31872 COAST HIGHWAY
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City | LAGUNA BEACH
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State | CA
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Zip | 92651
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Country | US
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Telephone | 949-226-2608
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95013845
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License Number State | CA
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